Download Free Medical Educational Session on Tevar-Complex Evar in the VQI PowerPoint Presentation

Educational Session on Tevar-Complex Evar in the VQI PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Educational Session on TEVAR/Complex EVAR in the VQI" by Grace J. Wang, MD, MSCE, FACS.

This medical PowerPoint presentation talks about TEVAR (Thoracic Endovascular Aneurysm Repair) and Complex EVAR (Endovascular Aneurysm Repair) in the VQI (Vascular Quality Initiative).

TEVAR (Thoracic Endovascular Aneurysm Repair) and Complex EVAR (Endovascular Aneurysm Repair) are minimally invasive procedures used to treat thoracic and abdominal aortic aneurysms, respectively. The VQI (Vascular Quality Initiative) is a collaborative effort of vascular surgeons and other healthcare professionals aimed at improving the quality of vascular care.

Tags : TEVAR, Thoracic Endovascular Aneurysm Repair, Complex EVAR, Endovascular Aneurysm Repair, VQI, Vascular Quality Initiative, thoracic aortic aneurysms, abdominal aortic aneurysms, vascular surgeons, vascular care, Cardiothoracic Surgery, cardiology, cardiology PowerPoint presentation

Published on : Mar 19, 2023 | Views : 1254 | Downloads : 9

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Slide 1-

Educational Session on TEVAR/Complex EVAR in the VQI Grace J. Wang, MD, MSCE, FACS Associate Professor of Surgery Hospital of the University of Pennsylvania Vascular Annual Meeting, 2021
Slide 2-

Review the relevant data abstraction, organized by tabs: Demographics/History Procedure Aortic Devices Branches Postoperative Long term followup Outline
Slide 3-

Aneurysm Dissection Aneurysm from Dissection Trauma Penetrating Aortic Ulcer Intramural Hematoma (IMH) PAU with IMH Aortic Thrombus TEVAR/Complex EVAR Registry includes many pathologies
Slide 4-

Zones of disease Particularly important in aortic dissection Proximal Zone of disease Distal Zone of disease For dissection, Primary entry tear zone Reporting standards for thoracic endovascular aortic repair (TEVAR) Mark F. Fillinger, MD Roy K. Greenberg, MD, James F. McKinsey, MD, Elliot L. Chaikof, MD Society for Vascular Surgery Ad Hoc Committee on TEVAR Reporting Standards JVS, 2010
Slide 5-

Pain Aneurysm Refractory hypertension Rupture Malperfusion Uncomplicated Rapid expansion Dissection Indication
Slide 6-

Malperfusion and branch vessel involvement True lumen becomes compressed during systole, causing malperfusion when the dissection extends past the visceral segment When dissection extends into branch vessel (C and D), dynamic or static obstruction can occur In longstanding cases (E) vessel distal to dissection may thrombose, necessitating thrombectomy or surgical bypass
Slide 7-

Defined by the 30 day cutpoint in VQI Acute <=30 days, Chronic > 30 days Chronicity of Dissection
Slide 8-

Procedure variables-Intravascular Ultrasound (IVUS) Especially important in dissection cases Confirm your wire is through true lumen Confirm where branch vessels of the visceral aorta and the arch emanating from Dynamic, real-time Helpful for sizing of the graft or deciding whether to extend stent
Slide 9-

Percutaneous, femoral Direct cutdown on femoral (with or without patch or endarterectomy), transverse or vertical May or may not need to do adjunctive stenting Iliac, retroperitoneal Abdominal aorta Ascending aorta Access
Slide 10-

Direct iliac puncture: favored approach for compromised access Retroperitoneal cutdown Exposure of the common iliac artery Two circumferential pursestrings, or interrupted stitches Parmer, S. and Carpenter, J., JVS 2006
Slide 11-

Iliac conduit Dacron limb anastomosed to common iliac artery and brought through a separate incision at the femoral level Accessed by Seldinger technique
Slide 12-

Arm-neck access Commonly left brachial-femoral access for branched thoracic endografting Allows for safe delivery/tracking of left subclavian branch stent into left subclavian artery Other sites include axillary as well as carotid, depending on specific branches included in stent graft repair
Slide 13-

Entry flow: If pathology is Dissection Type IA Entry flow Type IB Entry flow Type II Entry flow Type “R” entry flow-distal visceral fenestrations
Slide 14-

False lumen treatment Septal fenestration False lumen coil False lumen plug Rutherford chapter on dissection Annals of Vascular Surgery, 2015-01-01, Volume 29, Issue 1, Pages 125.e13-125.e17
Slide 15-

Endoanchors Can be placed at the time of index procedure or to address Type I endoleaks
Slide 16-

Endoleaks Ia Ib Ic II III IV V J Vasc Surg 2020 Aug;72(2):445-455. doi: 10.1016/j.jvs.2019.09.055. Epub 2020 Jan 21.
Slide 17-

Iliac Branch Endograft Used to treat common iliac artery aneurysms Preserves internal iliac artery flow Distal endpoint External and internal (branched) Oderich, et al, Endovascular Today, August 2017
Slide 18-

Fenestrated Abdominal Aortic Aneurysm (AAA) Endograft-commercially available Fenestrations for the renal arteries Typically a scallop for SMA, although large fenestration for SMA and celiac scallop also possible
Slide 19-

Endovascular thoracoabdominal aortic aneurysm (TAAA) repair Fenestrated Fen-branch Branched Side-arm branch Mayo clinic Endovascular repair of complex aortic aneurysms, 2014
Slide 20-

Pivotal-branch (P-branch) Trial graft Designed to be off-the shelf
Slide 21-

Chimney and Periscope
Slide 22-

Reinterventions Retrograde type A dissection after TEVAR Repair dissection with Partial device removal Distal anastomosis sewn to portion of prior TEVAR
Slide 23-

Questions?